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背景与目的:胰腺癌是预后很差的消化道肿瘤,常规的全身化疗效果很不理想。本实验探讨幼猪胰腺区域血管结扎后动脉灌注化疗的安全性和可行性。方法:14只幼猪分为3组,A组和B组分别行胃十二指肠动脉及脾动脉结扎并置管;C组行左耳缘静脉穿刺。3组动物分别自上述途径,60 m in内滴注氟尿嘧啶(5-FU)(20mg/kg)。用药后抽取门静脉和颈静脉血及胰腺组织测5-FU浓度;灌注前后抽取颈静脉血测淀粉酶、胰岛素、葡萄糖水平;取胰腺标本行组织病理检查。结果:80 m in和100 m in时,A组和B组门静脉药物浓度显著高于C组(P<0.05,P<0.01)。颈静脉血5-FU浓度在20 m in、40 m in和60 m in时,A组和B组均明显低于C组。A组和B组胰腺组织内5-FU浓度均明显高于C组(P<0.01)。各组于灌注前、灌注开始后2 h、灌注后24 h淀粉酶、胰岛素、葡萄糖水平均无明显变化。区域灌注后HE染色下多数标本中胰腺组织正常,少数出现不同程度胰腺组织水肿,无明显坏死改变。ABC免疫组化染色下胰岛结构亦多正常,少数胰岛内出现淋巴细胞,个别有胰岛β细胞轻度受损。结论:胰腺区域血管结扎后灌注化疗与全身化疗相比极大增高胰腺组织内的5-FU浓度,显著降低灌注期间周围循环中药物浓度,不影响血清淀粉酶、胰岛素、葡萄糖水平,对胰腺组织、胰岛β细胞无明显损伤。
Background and Objective: Pancreatic cancer is a poor prognosis of gastrointestinal cancer, the effect of conventional systemic chemotherapy is not ideal. This experiment was to investigate the safety and feasibility of intra-arterial infusion chemotherapy in the pancreas of piglets after vascular ligation. Methods: 14 young pigs were divided into 3 groups. Gastroduodenal artery and splenic artery were ligated and placed in group A and group B, respectively. In group C, the left ear marginal vein was punctured. Three groups of animals were infused with 5-fluorouracil (20-mg / kg) intravenously within 60 mins of the above route. After treatment, the concentration of 5-FU in portal vein, jugular vein and pancreas was measured. The levels of amylase, insulin and glucose in the jugular vein were measured before and after perfusion. Histopathological examination was performed on pancreatic specimens. Results: The portal vein drug concentrations in group A and group B were significantly higher than those in group C at 80 and 100 mins (P <0.05, P <0.01). When the concentration of 5-FU in jugular vein was 20 m in, 40 m in and 60 m in, the A and B groups were significantly lower than those in C group. The concentration of 5-FU in group A and group B were significantly higher than that in group C (P <0.01). Before the perfusion, the levels of amylase, insulin and glucose did not change significantly at 2 h after perfusion and 24 h after perfusion. Pancreatic tissue was normal in most of the specimens under regional HE staining. There were a few pancreatic edema in different degrees, with no obvious necrosis. ABC immunohistochemical staining islet structure is also more normal, a small number of islets appear in the lymphocytes, individual pancreatic β-cell mild damage. CONCLUSION: Compared with systemic chemotherapy, perfusion chemotherapy in the pancreas region significantly increases the concentration of 5-FU in the pancreas and significantly reduces the drug concentration in the peripheral circulation during perfusion. It does not affect serum amylase, insulin, and glucose levels, , Islet β cells without significant damage.